Long-term Outcomes for Late-Phase Kienböck's Tenoarthroplasty.

Background: In late Kienbӧck's, the lunate is fully fragmented and nonreconstructible. Replacing the lunate with a pyrocarbon prosthesis preserves load distribution and avoids carpectomy or fusion, but leaves the wrist intrinsically unstable, requiring additional soft-tissue stabilization techniques.

Methods: Five men and 7 women with a mean age of 43 (±15) years underwent prosthetic replacement of the lunate with dual bundle scaphoid-triquetrum tenodesis for carpal stabilization.

Matching Kienböck's Treatment Options to Specific Features of Each Case.

Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate.